Dermatologic Surgery at Crystal Run

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

154268 Issued in NY

Legal business name

DERMATOLOGIC SURGERY AT CRYSTAL RUN

Practice address

7A Medical Park Dr
Pomona, NY 10970-3516

Phone

(845) 354-1169

Fax

(845) 362-5126

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yehuda David Eliezri, M.D.NPI 1801837240

Title

President

Phone

(845) 692-3376

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yehuda David Eliezri, M.D.

  • Procedural Dermatology Physician
  • Pomona, NY
  • NPI 1801837240
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164509246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 RYKOWSKI LN",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414018",
            "telephone_number": "845-692-3376",
            "fax_number": "845-692-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7A MEDICAL PARK DR",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703516",
            "telephone_number": "845-354-1169",
            "fax_number": "845-362-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGIC SURGERY AT CRYSTAL RUN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELIEZRI",
        "authorized_official_first_name": "YEHUDA",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-692-3376",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "154268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Defour-Pierce, PSY.D., LMHC
• Brittany Delahanty, COTA/L
• John Robert Delisi, D.C.
• Patricia Dellagreca, RN
• Dental Arts Associate, P.C
• Edward Brady Desciak, M.D.
• Vijaya Deshpande
• Sharon Desimone-O'Dowd, RN
• Joseph Eli Deutsch, M.D.
• Karen Devlin-Bronstein

• MOHS-Micrographic Surgery Physician in Pomona, NY
• Providers in Pomona, NY by specialty
• MOHS-Micrographic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.